Bright Futures: The Teenage Years

1. Bright Futures: The Teenage Years Paula Duncan, MD, FAAP September 4, 2009

2. Paula Duncan, MD, FAAP Chairperson, AAP Bright Futures Pediatric Implementation Project Professor of Pediatrics University of Vermont College of Medicine

3.  Learning Objectives • Learn about key adolescent priorities and recommendations from the Bright Futures Guidelines for Health Supervision of Infants, Children, And Adolescents, 3rd Edition. • Learn about tools and strategies for measurable implementation of Bright Futures in an adolescent health supervision visit. • Discuss and share with call participants resources, tools and strategies for Bright Futures implementation with the adolescent population.

5. The Team Joseph Hagan, MD Judith S Shaw, RN, MPH, EdD Paula Duncan, MD Mary Margaret Gottesman, PhD, RN, CPNP Darcy Steinberg-Hastings, MPH Jane Bassewitz, MA Amy Pirretti, MS

6. The Adolescent Expert Panel Marty Fisher, MD, Co Chairperson Fran Biagoli, MD, Co Chairperson Pam Burke PhD, RN, BC-FNP,PNP Arthur Elster, MD Alma Golden, MD Katrina Holt MPH,MS,RD M. Susan Jay, MD Jamie Martinez, MD

7. What Are the Bright Futures Guidelines? Comprehensive health supervision guidelines: • Developed by multidisciplinary child health experts—providers, researchers, parents, child advocates • Provide framework for well-child care from birth to age 21 • Present single standard of care based on health promotion and disease prevention model • Include recommendations on immunizations, routine health screening, and anticipatory guidance • Replace the former AAP Guidelines for Health Supervision

8. To make scientific, evidence informed recommendations on priorities, physical exam , screening tests and anticipatory guidance • Approach to evidence and rationale • Expert panel • Evidence panel • USPSTF recommendations for children • Adult USPSTF recommendations • CDC, AAP,AAFP, NAPNAP,GAPS, IOM policies • Two public reviews

9. 2000 & 2002 …is a set of principles, strategies and tools that are theory - based, evidence - driven, and systems - oriented, that can be used to improve the health and well-being of all children through culturally appropriate interventions that address the current and emerging health promotion needs at the family, clinical practice, community, health system and policy levels.

10. How do the 3rd Edition Guidelines differ from previous editions? Overviewof Changes • Structure of the Book • Changes to the recommendations

11. Bright Futures in Action Bright Futures in Action: Adolescent Visit

12. Context The early adolescent is embarking on a journey of remarkable transitions and transformations—physically, cognitively, emotionally, and socially—and the pace at which these physical and emotional changes occur varies widely.

13. Who has an 11-14 year old?

16. ANTICIPATORY GUIDANCE • For the parent • Discuss youth responsibilities in the family and how they change with age. • Get to know your child’s friends and encourage him to make good decisions about choosing friends. • Discuss your expectations for dress, friends, media, and activities, and supervise your child. • Develop a pattern of communication and support him as an independent person. Make time every day to talk (mealtime, bedtime, drive time, or checkin time) about lots of things, not just about difficult or unpleasant topics. • For the youth • This is an important time to stay connected with your parents. You might not always agree on everything, but work with your family to solve problems, especially around difficult situations or topics. SOCIAL AND ACADEMIC COMPETENCE Connectedness with family, peers, and community; interpersonal relationships; school performance Young people are more likely to make healthy choices if they stay connected with family members, and if clear rules and limits are set. Remind parents that, although their child’s friends are becoming increasingly important to him, they should not underestimate their own ability to positively influence his opinions and decisions. This shift in the balance can be difficult for parents to deal with, but it is an important time to continue to cement family relationships. This effort will pay off later because close family ties are an important protective, risk-reducing factor in middle and late adolescence. Connection to parents and other responsible adults is associated with a reduced number of risk behaviors. SAMPLE QUESTIONS Ask the parent How are you getting along as a family? What do you do together? Do you understand your child’s world and daily life? Ask the youth How do you get along with your family? What do you like to do together? How closely connected do you feel to your family’s cultural and faith life?

17. Date of Screening_____ • HEEADSSS Assessment • Home(connection/independent decision-making) • Education (competence) • Eating • Activities (physical activity, helping out) • Drugs • Sex • Safety • Suicide (coping, resiliency, self confidence) Check Indicates a Preventative Screening • Vision • Hearing • Anemia • Cholesterol • TB • STI • PAP • Pregnancy • CRAFFT? Y / N+2 Office Intervention Y/ N Referral Y / N

18. Bright Futures Tool and Resource Kit • Designed to accompany and support the Bright Futures Guidelines, 3rd Edition • Organized compilation of current standards & materials on preventive health supervision & health screening. • Pre-Visit Questionnaires • Visit Documentation Forms • Parent/Patient Education Handouts • Parent/Patient Education Tools • Developmental and Behavioral Screening • Practice Management Tools for Preventive Care • Developing linkages to Community Resources • www.brightfutures.aap.org

19. Bright Futures Tools: 15 -17 Visit

20. 15 to 17 Year Visit 20

21. 15 to 17 Year Visit 21

22. Bright Futures: Medical Screening Table

23. Bright Futures: Previsit Questionnaire

24. Bright Futures: Previsit Questionnaire

25. Bright Futures: Supplemental Questionnaire

26. Bright Futures: Supplemental Questionnaire

27. Bright Futures: Supplemental Questionnaire

28. Bright Futures: Documentation Form

29. Bright Futures: Patient Handout

30. Bright Futures: Parent Handout

31. Practice Based Implementation Strategies • Use a recall reminder system • Develop community linkages • Compile a resource list of community agencies • Develop a single referral form that can be used to communicate with multiple agencies • Identify an office staff person to be responsible for updating community list and keeping track of referrals • Cultivate office team involvement and buy-in • Organize community practice meetings • Identify small steps for implementing new change • Use measurement

32. References • Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics • Duncan PM, Garcia AC, Frankowski BL et al. Inspiring healthy adolescent choices: A rationale for and guide to strength promotion in primary care. J Adol Health 41 (2007) 525-535. • Recommendations for Preventive Pediatric Health Care. American Academy of Pediatrics. Pediatrics. 120:6 (1367). 2007 • P.M. Duncan, E. D. Duncan, J. Swanson. Bright Futures: The Screening Table Recommendations; Pediatric Annals 37(3) 152-158.

33. Contact Information QuIIN Phone: 847 434 4260 E-mail:quiin@aap.org New Web site:http://quiin.aap.org Staff Contacts: Jill Healy, MS: Project Manager Keri Thiessen, MEd, Senior Health Policy Analyst Bright Futures Phone: 847 434 4223 E-mail:brightfutures@aap.org New Web site:www.brightfutures.aap.org Staff Contacts Jane Bassewitz, MA; Manager, Bright Futures Education Center Amy Pirretti, MS; Manager, Materials Development and Promotion